Professor leads research into suicide attempts

Suicide is the most common cause of death in 15 to 24-year-old males in Ireland. A study into those in despair aims to find out what these men need to stay alive.David Labanyi reports

A funding request for the first qualitative study of attempted suicide in young men in Ireland will shortly be submitted to the Health Research Board.

The research will be led by Prof Chris Stevenson who was recently appointed to the newly created post of professor of mental health nursing at Dublin City University. She plans to study the disturbing rise in the number of young men in Ireland taking their own lives.

The all-Ireland study will see researchers in DCU collaborating with a university in Northern Ireland. Although not yet confirmed, it is expected the University of Ulster will co-ordinate the research in the North. The first set of interviews is expected to get underway in the North next January, and, if funding is granted, research will begin a couple of months later in the Republic.

Behind the research is an awareness that mental health nurses are currently not properly trained to deal with people with severe mental health issues.

"The weaknesses in the training of Irish and UK nurses are very similar and can be surmised as professional avoidance in engaging meaningfully with the person," says Prof Stevenson.

This deficiency was first identified by Prof Stevenson when she worked as a community psychiatric nurse before joining the University of Teeside. She later researched the nursing response to mental health in the Meaningful Caring Study (2001 to 2004), which was conducted at that university.

This study found nursing responses to people at risk "were really poor".

"Often the response would be simply observing a person, at other times a patient would be over-medicated or sectioned under the Mental Health Act. So we became quite concerned that nurses weren't able to work effectively with people who are in that particular dark place."

To find out what patients needed, the Teeside researchers interviewed people who had made a very serious suicide attempt. "We waited until they were clinically judged to be out of risk - usually after about four weeks - and then asked them what they felt they needed from the nurses caring for them. What we found is that medication is not the whole answer and that the nurses were seen as ill-prepared to work closely with mentally ill patients."

Prof Stevenson describes the care process required using the words of one of the Teeside research respondents: "There were these two women [ crisis team nurses] sat on the edge of my bed dragging me back, mentally, intellectually and emotionally by making me engage with them."

Her research in Ireland is going to focus on the group showing the most dramatic rise in suicides in Ireland - young men. Since 1990 the number of people taking their own lives in the State has risen by 8 per cent. In males of 15-24 years of age the increase has been 70 per cent, making it the most common cause of death for this group. Central to her research is an awareness that for every suicide there can be up to 20 attempts.

In Ireland last year 457 people took their own lives and Irish hospitals recorded more than 11,000 cases of attempted self-harm in 2004. Prof Stevenson's focus is on meeting the needs of the young men who engage in serious self-harm.

She feels the creation of her post, the first of its kind in the State, and her appointment is a response to a lack of nursing research set in an Irish context and also to the changes facing the profession.

Earlier this month the Government published details of a 10-year strategy to reduce the number of people taking their own lives. Reach Out - The National Strategy for Action on Suicide Prevention will focus on mental health awareness programmes, education and other support services.

An office for suicide prevention will be set up under the Health Service Executive headed by Geoff Day, former North Eastern Health Board assistant chief executive.

"The proposed health reforms will see the development of community health teams which will require nurses to work in a different way and I think they will need a huge amount of leadership," says Prof Stevenson.

A key difference Prof Stevenson noted since taking up her DCU post three months ago is that people with severe mental illnesses are normally in acute inpatient services. "This is different from England where we found crisis teams and psychiatry teams to help maintain people in the community."

She says the proposed healthcare reforms in Ireland will require a huge development of community mental health teams. "Those people working on those teams are going to have to learn very quickly how to respond to people who are in great need."

Prof Stevenson's research will directly inform the nurse training programmes at DCU, where approximately 60 of the 200 student nurses enrolling each year specialise in mental health.

She says mental health nursing in Ireland, and in the UK and US, has serious problems in recruitment and retention of skilled staff. Shortages are often covered by agency staff and "in terms of a consistent approach for people with serious emotional needs, that is often not best delivered by agency nurses".

Increasing the number of nurses in this area requires a combination of improved training and working conditions and also an increase in the clinical training places for student nurses, she says.

Prof Stevenson says her goal is to provide "good quality evidence-based research for nurses in Ireland that takes account of the unique circumstances here".